Benign Pigmented Lesions Research Articles

Intense pulsed light for skin rejuvenation: evidence base, indications and risks

For over 20 years, intense pulsed light (IPL) has been used for therapeutic indications such as common signs of photoageing, benign pigmented and vascular lesions, and hair removal. IPL is a widely used treatment modality in medical aesthetic clinics and is recognised for its comparable results to laser treatments. IPL is not only more affordable for patients, but also has less downtime post procedure. However, compared with other laser devices in this fast-evolving medical technology market, does this relatively inexpensive treatment with very little downtime still have a place in modern aesthetic practice? Laser expert David Cauger (2007) described IPL as ‘a jack of all trades and master of two’, as well as an excellent treatment for both ‘age spots’ and telangiectasia. However, he also reported that, for the majority of indications, most modern monochromatic lasers outperform IPL. Does IPL still have a useful place in the modern aesthetic setting, or have laser treatments taken over?

Current Concepts in Aesthetic Laser Medicine: The 694-Nm Q-Switched Ruby-Laser

Quality-switched (q-switched) laser systems are the gold standard for the treatment of benign pigmented lesions and tattoo removal. A frequently used system is the q-switched ruby laser that emits monochromatic light at the wavelength of 694 nm. This system is used for the removal of age spots (senile lentigines), seborrhoeic keratosis, tattoos, and other dyschromatoses. The increasing need for the removal of, for example, age spots and unwanted tattoos, reflects both the wish of our ageing society to preserve a youthful appearance and the steadily growing prevalence of tattoos. This review highlights the potential, limitations, and novel treatment concepts of using q-switched ruby laser systems.

CR0298 Oral pigmented lesion

Oral melanoacanthoma (OMA), a term first coined by Mishima and Pinkus in 1960, is an uncommon, benign pigmented lesion of the oral mucosa. The rapid growth of OMA may mimic malignant melanoma. The exact etiology of OMA is not clear, but constant trauma has been suggested as a causative factor.

Automatic Detection of Malignant Melanoma using Macroscopic Images

In order to distinguish between benign and malignant types of pigmented skin lesions, computerized procedures have been developed for images taken by different equipment that the most available one of them is conventional digital cameras. In this research, a new procedure to detect malignant melanoma from benign pigmented lesions using macroscopic images is presented. The images are taken by conventional digital cameras with spatial resolution higher than one megapixel and by considering no constraints and special conditions during imaging. In the proposed procedure, new methods to weaken the effect of nonuniform illumination, correction of the effect of thick hairs and large glows on the lesion and also, a new threshold-based segmentation algorithm are presented. 187 features representing asymmetry, border irregularity, color variation, diameter and texture are extracted from the lesion area and after reducing the number of features using principal component analysis (PCA), lesions are determined as malignant or benign using support vector machine classifier. According to the dermatologist diagnosis, the proposed processing methods have the ability to detect lesions area with high accuracy. The evaluation measures of classification have indicated that 13 features extracted by PCA method lead to better results than all of the extracted features. These results led to an accuracy of 82.2%, sensitivity of 77% and specificity of 86.93%. The proposed method may help dermatologists to detect the malignant lesions in the primary stages due to the minimum constraints during imaging, the ease of usage by the public and nonexperts, and high accuracy in detection of the lesion type.

Differences in the known cellular composition of benign pigmented skin lesions reflected in computer-aided image analysis.

BackgroundComputer-aided image analysis (CAIA) has been suggested as an effective diagnostic tool for pigmented skin lesions (PSLs), especially melanoma. However, few studies on benign PSLs have been reported.ObjectiveThe purpose of this study was to evaluate benign PSLs with our CAIA software and analyze the differences between the parameters of those lesions.MethodsBy using homegrown CAIA software, we analyzed 3 kinds of PSLs-nevus, lentigo, and seborrheic keratosis. The group of seborrheic keratosis was divided into pigmented seborrheic keratosis, sebolentigine, and hyperkeratotic seborrheic keratosis. The CAIA was used to extract the color, as well as the morphological, textural, and topological features from each image.ResultsIn line with clinical observations, the objective parameters indicated that nevus was dark and round, lentigo was small and bright, and seborrheic keratosis was large and spiky. The surface of nevus showed the highest contrast and correlation. In topological analysis, the concentricity clearly separated melanocytic lesions from seborrheic keratosis. The parameters of pigmented seborrheic keratosis were between those of typical nevus and seborrheic keratosis.ConclusionWe confirmed that definite correlations exist between the subjective differentiation by experts' examination and the objective evaluation by using CAIA. We also found that the morphological differences observed in CAIA were greatly influenced by the composition ratios of keratinocytes and melanocytes, which are already known histopathological characteristics of each PSL.

Congenital hypertrophy of the retinal pigment epithelium

Congenital hypertrophy of the retinal pigment epithelium is a benign pigmented lesion of the posterior pole with a unique clinical appearance. It is flat, round, and has sharp edges. While it is usually black, it may have internal lacunae without pigment. The lesion may also be all hypopigmented. Over many years, the lesions may grow slightly and change their pigmentation. Even though malignant transformation is extremely rare, annual examinations should be performed.

Abstract 3914: In vivo label-free examination of early-stage melanoma formation.

Abstract Rationale. One of the most lethal forms of skin cancer is the cutaneous melanoma that develops from melanocytes. Distinguishing between benign and malignant pigmented lesions is difficult and often requires excision for pathological examination. In most malignant melanoma, an early genetic alteration of the melanocytes is a mutation of the BRAF oncogene. We have used a pre-clinical mouse model that allows conditional induction of the BRAF oncogene and deletion of Pten tumor suppressor in melanocytes. Upon induction, these animals develop melanomas that reproduce many of the histological and molecular changes observed in humans. With pump-probe imaging in vivo we have non-invasively detected the early modifications that harbor melanoma formation. We have investigated the sub-cellular expression of melanin as an indicator of tumor progression along with the morphological modifications that characterize the pigmented malignant lesions. Methods. Transgenic mice (Tyr::CreER(Tg/+); BRaf(CA), Pten(lox/lox)) were treated topically 4-hydroxytamoxifen (4-OHT: 1.5uL of 5mM) to induce conversion of BRaf(CA) to BrafV600E and Pten silencing (n=4). In vivo pump-probe microscopy was performed to acquire 3D, noninvasive images of the pigmented lesions, using the melanin pigment itself for imaging contrast. Images were acquired 2-day after 4-OHT application, at 2 and 4 weeks. C54 mice (n=2) were used as control. Pump-probe was combined with multiphoton autofluorescence. In vivo confocal microscopy was performed for morphological evaluation and blood flow detection. Afterwards, mice were euthanized, the skin was resected and sections were evaluated after staining with hematoxylin-eosin (HE). Results. Pigmented lesions were detectable by pump-probe microscopy two days after the treatment. The second scan (2-week) showed strong pigmentation present both, superficially and around the canal root of the hairs. The subsequent scan (4-week) showed the invasive nature of the lesions with altered cellular architecture resembling vertical growth melanomas. Pigmentation and atypical cellular proliferation was also present in the deeper layers of the dermis indicating the invasiveness of the tumor. These findings were confirmed by histological examination of the HE slides. In vivo confocal microscopy showed prominent convoluted vessels with large caliber and high blood flow confirming the malignant nature of the lesions. The control subjects did not show the cellular formations typical of the melanocytic lesions. Conclusions. Pump-probe laser microscopy detected in vivo and label-free the morphological changes that take place in melanoma formation. In contrast to the control subjects, melanocytic lesions were easily identifiable 2- day after the treatment with 4-OHT. This new non-invasive diagnostic approach is helpful in identifying early stage cutaneous melanomas. Citation Format: Simone Degan, Jesse W. Wilson, Christina S. Gainey, Julie Kent, Traci L. Reddick, Kelly Nelson, Maria A. Selim, Warren S. Warren. In vivo label-free examination of early-stage melanoma formation. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3914. doi:10.1158/1538-7445.AM2013-3914

Correlation between dermoscopic and histopathological diagnoses of atypical nevi in a dermatology outpatient clinic of the Medical School of São José do Rio Preto, SP, Brazil

BACKGROUNDThe incidence of cutaneous melanoma is increasing worldwide. Since it is an aggressive neoplasm, it is difficult to treat in advanced stages; early diagnosis is important to heal the patient. Melanocytic nevi are benign pigmented skin lesions while atypical nevi are associated with the risk of developing melanoma because they have a different histological pattern than common nevi. Thus, the clinical diagnosis of pigmented lesions is of great importance to differentiate benign, atypical and malignant lesions. Dermoscopy appeared as an auxiliary test in vivo, playing an important role in the diagnosis of pigmented lesions, because it allows the visualization of structures located below the stratum corneum. It shows a new morphological dimension of these lesions to the dermatologist and allows greater diagnostic accuracy. However, histopathology is considered the gold standard for the diagnosis. OBJECTIVESTo establish the sensitivity and specificity of dermoscopy in the diagnosis of pigmented lesions suspected of malignancy (atypical nevi), comparing both the dermatoscopic with the histopathological diagnosis, at the Dermatology Service of the outpatient clinic of Hospital de Base, São José do Rio Preto, SP.METHODSAnalysis of melanocytic nevi by dermoscopy and subsequent biopsy on suspicion of atypia or if the patient so desires, for subsequent histopathological diagnosis.RESULTSSensitivity: 93%. Specificity: 42%. CONCLUSIONSDermoscopy is a highly sensitive method for the diagnosis of atypical melanocytic nevi. Despite the low specificity with many false positive diagnoses, the method is effective for scanning lesions with suspected features of malignancy.

The role of dynamic infrared imaging in melanoma diagnosis

Melanoma incidence and the lifetime risk are increasing at an alarming rate in the United States and worldwide. In order to improve survival rates, the goal is to detect melanoma at an early stage of the disease. Accurate, sensitive and reliable quantitative diagnostic tools can reduce the number of unnecessary biopsies, the associated morbidity as well as the costs of care in addition to improving survival rates. The recently introduced quantitative dynamic infrared imaging system QUAINT measures differences in the infrared emission between healthy tissue and the lesion during the thermal recovery process after the removal of a cooling stress. Results from a clinical study suggest that the temperature of cancerous lesions is higher during the first 45-60 seconds of thermal recovery than the temperature of benign pigmented lesions. This small temperature difference can be measured by modern infrared cameras and serve as an indicator for melanoma in modern quantitative melanoma detectors.

Squamous Cell Carcinoma Developing after CO2 Laser Resurfacing

Skin resurfacing with the carbon dioxide (CO(2)) laser is currently a popular means of improving rhytides and scars and has been reported useful in the treatment for photodamaged skin, including precancerous and benign skin lesions, as well as superficial benign pigmented lesions. We describe a 68-year-old man who developed rapid squamous cell carcinoma (SCC) on the resurfaced areas 3 weeks following CO(2) laser resurfacing. Rapid occurrence of SCC should be considered a rare complication, and we recommend carefully considering CO(2) laser resurfacing after excision of an SCC and surveying any cancer recurrences. We report a rare complication of CO(2) laser resurfacing. This report suggests that additional work in this area is warranted.

Reflectance confocal microscopy: a useful and non-invasive tool in the in vivo differentiation of benign pigmented skin lesions from malignant melanoma. Report of a case

The diagnosis of seborrheic keratoses (SK) undergoing regression can be challenging clinically and dermoscopically. We report a case of a SK with a history of change and equivocal dermoscopic features, thereby showing confocal features suggestive of solar lentigo/early SK. The present case emphasizes the potential value of reflectance confocal microscopy (RCM) in the differentiation of malignant from benign pigmented skin lesions.

Differentiation of Benign Pigmented Skin Lesions with the Aid of Computer Image Analysis: A Novel Approach

BackgroundThe differential diagnosis of common pigmented skin lesions is important in cosmetic dermatology. The computer aided image analysis would be a potent ancillary diagnostic tool when patients are hesitant to undergo a skin biopsy.ObjectiveWe investigated the numerical parameters discriminating each pigmented skin lesion from another with statistical significance.MethodsFor each of the five magnified digital images containing clinically diagnosed nevus, lentigo and seborrheic keratosis, a total of 23 parameters describing the morphological, color, texture and topological features were calculated with the aid of a self-developed image analysis software. A novel concept of concentricity was proposed, which represents how closely the color segmentation resembles a concentric circle.ResultsMorphologically, seborrheic keratosis was bigger and spikier than nevus and lentigo. The color histogram revealed that nevus was the darkest and had the widest variation in tone. In the aspect of texture, the surface of the nevus showed the highest contrast and correlation. Finally, the color segmented pattern of the nevus and lentigo was far more concentric than that of seborrheic keratosis.ConclusionWe found that the subtle distinctions between nevus, lentigo and seborrheic keratosis, which are likely to be unrecognized by ocular inspection, are well emphasized and detected with the aid of software.

Choroidal neovascularization secondary to choroidal nevus simulating an inflammatory lesion

Choroidal nevi are the most common benign pigmented lesions of the fundus. Choroidal neovascularization is a rare complication of choroidal nevi. We report herein a young patient managed successfully with intravitreal bevacizumab injections for juxtapapillary choroidal neovascularization secondary to choroidal nevus simulating an inflammatory lesion.

An unusual clinical presentation of gingival melanoacanthoma

Gingival melanoacanthoma is a rare, benign pigmented lesion characterized clinically by sudden onset and rapid growth of a macular brown black lesion and histologically by acanthosis of superficial epithelium and proliferation of dendritic melanocytes. This article reports a previously undescribed case of pigmented unilateral diffuse gingival enlargement, which on histopathological examination proved to be melanoacanthoma. Intraoral examination revealed pigmented unilateral diffuse gingival enlargement in relation to second and third quadrants buccally, palatally/lingually. Based on these clinical findings, gingivectomy was performed and the excised tissue was sent for biopsy. Microscopic examination revealed acanthotic and parakeratotic surface epithelium with dendritic melanocytes distributed in basal and suprabasal layers of the epithelium. 1 year follow-up recall revealed no recurrence of lesion at the surgical sites. Our patient exhibits an unusual clinical presentation of melanoacanthoma of gingiva. Pigmented gingival overgrowth of recent origin and without any etiologic factors warrants histopathologic examination.

Medicolegal Issues with Regard to Melanoma and Pigmented Lesions in Dermatopathology

Understanding malpractice risk and practicing risk management strategies results in better care and a less stressful environment of practice. Errors in diagnosis are most commonly related to melanoma and neoplasms of the skin. To offset the threat of malpractice litigation, malpractice data can be used to focus safety efforts on common diagnostic errors. Recognition of sources of error in the analysis of pigmented lesions by dermatopathologists, and the development of new immunohistochemical or genotypic techniques for the recognition and distinction of malignant disease from benign pigmented lesions, will also provide important improvements in care and diagnosis in the future.

Láser Q-Swtiched Nd: YAG 1.064 nm para el tratamiento del nevus de Ota: resultados en 22 pacientes y revisión de la literatura

Introduction and ObjectiveNevus of Ota (NO) is a facial cutaneous melanosis with a strong cosmetic impact. 1.064-nm Q-Switched (QS) neodymium-doped yttrium aluminum garnet (Nd:YAG) laser can selectively destroy melanocytes and melanosomas causing pigmentation and is an effective and well tolerated alternative in the treatment of NO. The objective of this study was to evaluate the effectiveness and adverse events of 1.064-nm Nd:YAG laser in the treatment of NO. Patients and MethodsWe performed a retrospective analysis of case files and photographic sessions of patients with benign pigmented lesions treated with 1.064-nm Nd:YAG laser between 2005 and 2010 in our center. ResultsTwenty-two patients with NO were found. 1.064-nm Nd:YAG laser, with a mean spot of 3mm, a mean fluency of 5J/cm2 (range 4–10J/cm2) and a frequency of 10Hz was used. The mean number of sessions per patient was six (range 4 to 12 sessions). All patients had a clear rate of more than 50%, which was considered a favorable outcome. The only adverse event consisted of mild and transitory crusts. ConclusionsThis case-series confirms the results of previously published reports, showing the high efficacy of 1.064-nm Nd:YAG laser in the treatment of NO without severe adverse events. This treatment is cosmetically safe, with no evidence of long-term pigmentation or scarring. We believe the 1.064-nm QS Nd:YAG laser should be considered a first-line treatment in the management of NO.

Neonatal Blue Light Phototherapy and Melanocytic Nevi: A Twin Study

Neonatal blue light phototherapy (NBLP) has been widely and successfully used for the treatment of neonatal jaundice to reduce the plasma concentration of bilirubin and, hence, to prevent kernicterus. Only a few and controversial data are available in the literature as to how NBLP influences melanocytic nevus development. Our goal was to conduct a twin study with the aim of better understanding the role of NBLP in melanocytic nevus development. We also investigated the roles of other environmental and constitutional factors in nevus formation. Fifty-nine monozygotic and dizygotic twins were included in this cross-sectional study. One of the twin members received NBLP, and the other did not. A whole-body skin examination was performed to determine the density of melanocytic skin lesions. The prevalence of benign pigmented uveal lesions was evaluated during a detailed ophthalmologic examination. A standardized questionnaire was used to assess data relating to constitutional, sun-exposure, and other variables. To search for possible gene-environmental interactions involved in the appearance of pigmented lesions, the melanocortin 1 receptor variants and the I439V polymorphism of histidine ammonia-lyase genes were also determined in the enrolled twins. NBLP was associated with a significantly higher prevalence of both cutaneous and uveal melanocytic lesions. No association was found between the examined gene polymorphisms and the number of pigmented alterations in the examined study group. Our data suggest that NBLP could well be a risk factor for melanocytic nevus development. Phototherapy with blue-light lamps is a standard and essential therapeutic modality in neonatal care; therefore, additional in vivo and in vitro studies are necessary to establish its potential long-term adverse effects.

The usefulness of c-Kit in the immunohistochemical assessment of melanocytic lesions.

C-Kit (CD117), the receptor for the stem cell factor, a growth factor for melanocyte migration and proliferation, has shown differential immunostaining in various benign and malignant melanocytic lesions. The purpose of this study is to compare c-Kit immunostaining in benign nevi and in primary and metastatic malignant melanomas, to determine whether c-Kit can aid in the differential diagnosis of these lesions. c-Kit immunostaining was performed in 60 cases of pigmented lesions, including 39 benign nevi (5 blue nevi, 5 intra-dermal nevi, 3 junctional nevi, 15 cases of primary compound nevus, 11 cases of Spitz nevus), 18 cases of primary malignant melanoma and 3 cases of metastatic melanoma. The vast majority of nevi and melanomas examined in this study were positive for c-Kit, with minimal differences between benign and malignant lesions. C-Kit cytoplasmatic immunoreactivity in the intraepidermal proliferating nevus cells, was detected in benign pigmented lesions as well as in malignant melanoma, increasing with the age of patients (P=0.007) in both groups. The patient’s age at presentation appeared to be the variable able to cluster benign and malignant pigmented lesions. The percentage of c-Kit positive intraepidermal nevus cells was better associated with age despite other variables (P=0.014). The intensity and percentage of c-Kit positivity in the proliferating nevus cells in the dermis was significantly increased in malignant melanocytic lesions (P=0.015 and P=0.008) compared to benign lesions (compound melanocytic nevi, Spitz nevi, intradermal nevi, blue nevi). Immunostaning for c-Kit in metastatic melanomas was negative. Interestingly in two cases of melanoma occurring on a pre-existent nevus, the melanoma tumor cells showed strong cytoplasmatic and membranous positivity for c-kit, in contrast with the absence of any immunoreactivity in pre-existent intradermal nevus cells. C-Kit does not appear to be a strong immunohistochemical marker for distinguishing melanoma from melanocytic nevi, if we consider c-Kit expression in intraepidermal proliferating cells. The c-Kit expression in proliferating melanocytes in the dermis could help in the differential diagnosis between a superficial spreading melanoma (with dermis invasion) and a compound nevus or an intradermal nevus. Finally, c-Kit could be a good diagnostic tool for distinguishing benign compound nevi from malignant melanocytic lesions with dermis invasion and to differentiate metastatic melanoma from primary melanoma.

Body-site distribution of skin cancer, pre-malignant and common benign pigmented lesions excised in general practice

Concern about skin cancer is a common reason for people from predominantly fair-skinned populations to present to primary care doctors. To examine the frequency and body-site distribution of malignant, pre-malignant and benign pigmented skin lesions excised in primary care. This prospective study conducted in Queensland, Australia, included 154 primary care doctors. For all excised or biopsied lesions, doctors recorded the patient's age and sex, body site, level of patient pressure to excise, and the clinical diagnosis. Histological confirmation was obtained through pathology laboratories. Of 9650 skin lesions, 57·7% were excised in males and 75·0% excised in patients ≥ 50 years. The most common diagnoses were basal cell carcinoma (BCC) (35·1%) and squamous cell carcinoma (SCC) (19·7%). Compared with the whole body, the highest densities for SCC, BCC and actinic keratoses were observed on chronically sun-exposed areas of the body including the face in males and females, the scalp and ears in males, and the hands in females. The density of BCC was also high on intermittently or rarely exposed body sites. Females, younger patients and patients with melanocytic naevi were significantly more likely to exert moderate/high levels of pressure on the doctor to excise. More than half the excised lesions were skin cancer, which mostly occurred on the more chronically sun-exposed areas of the body. Information on the type and body-site distribution of skin lesions can aid in the diagnosis and planned management of skin cancer and other skin lesions commonly presented in primary care.

A PRELIMARY APPROACH FOR THE AUTOMATED RECOGNITION OF MALIGNANT MELANOMA

In this work, we are motivated by the desire to classify skin lesions as malignants or benigns from color photographic slides of the lesions. Thus, we use color images of skin lesions, image processing techniques and artificial neural network classifier to distinguish melanoma from benign pigmented lesions. As the first step of the data set analysis, a preprocessing sequence is implemented to remove noise and undesired structures from the color image. Second, an automated segmentation approach localizes suspicious lesion regions by region growing after a preliminary step based on fuzzy sets. Then, we rely on quantitative image analysis to measure a series of candidate attributes hoped to contain enough information to differentiate melanomas from benign lesions. At last, the selected features are supplied to an artificial neural network for classification of tumor lesion as malignant or benign. For a preliminary balanced training/testing set, our approach is able to obtain 79.1% of correct classification of malignant and benign lesions on real skin lesion images.